MEDICAL EXTERNSHIP REPORT
THE BROOKLYN HOSPITAL CENTER
New York,USA
February-April 2012
ROLPH RICHEME,MD
Third year General Surgery Resident
Justinien University Hospital(HAITI)
Plan
• Introduction
• Thanks
• Operating Theatre cases
• Residents and activities
• Other Rotations
• Special conferences
• Medical externship survey
• Money Report
• Leisure Time
• Worship
• Comments and suggestions
• Conclusion
Introduction
My name is Rolph Richeme, I am a General Surgery resident actually in third
year in Justinien University Hospital (Haiti).
I was selected to participate in a medical externship at The Brooklyn Hospital
Center,in Brooklyn,NY,11201, for a period of ninety days,starting February 1 to
April 30,2012.This is a special program achieved by the Association of Haitian
Physicians Abroad and SImACT.
Thanks
My gratefulness goes to :
- AMHE represented by Dr Paul Nacier and Dr Patrick Leblanc;also to Dr Louisdon
Pierre, to SImACT especially to Dr Lesly Kernisant;Dr Rodolphe Barrella,chief of
the General Surgery Department and Dr Yvel Zephyr the Training chief executive,
in Justinian University Hospital-Cap-Haitian,Haiti.
- Dr Louis J. Auguste,immediate AMHE past president,who visited me.He opened
doors for a rotation in a Trauma center in New York,as I asked him to for the next
haitian residents.He gave me hernia meshes for Haiti.
- Mrs Elourdes for her help in the vascular lab.
- Dr Duperval and especially to Mrs Duperval whoi was such a wonderful help
introducing me to the staff and for all OR gifts to help patients in Haiti.
- Dr Segun,a Family Practice Resident ,who helped us a lot with internet access.
- Dr Itaney Toussaint,a Family Medicine Resident,for his advices to a better
externship.
-St Aromand Richard for his great help attending two New York conferences,also
for all his informations and gifts of hernia meshes for patients in Haiti.
I am particularly thankful to Samuel L.Davis,president of Burn Advocates
network to sponsor my trip(Plane tickets,lodging,food) to Seattle,WA ,USA, to
attend the American Burn Association congress.We also used the occasion to
promote The Burn Center and Network in Haiti. I thank him for his help making
contacts to do rotation in a burn or trauma center in three other hospitals in New
York.Unfortunately that was never happened.
I owe much thanks to a surgeon Dr Bernard Rimpel for being a great
encouragement,a model,a mentor,and a professor. I am so grateful to his
precious surgical gifts to build the career…
I am especially grateful to Dr Patrick Leblanc,to Dr Myriam Germain and to Dr
Yves Jean Gilles for their precious contribution to the health of my family.
Operating Theatre cases
1-Herniorraphy Inguinal w/without mesh:open or laparoscopy in adults & children
2-Ventral herniorraphy w/without mesh biological and component separation
panniculectomy
3-Herniorraphy umbilical w/without mesh in adults and children
4-Hydrocelectomy in children
5-Circumcision in adults & children
6-Varicocelectomy
7-Orchidopexy in children
8-Suprapubic catheter tube insertion
9-Urinary stent insertion
10-Extracorporal shock wave lithotripsy ESWL
11-Cholecystectomy /laparoscopy
12-Fundoplicature
13-Gastric bypass/laparoscopy
14-Sleeve gastrectomy/laparoscopy
15-Laparoromy exploratory/gastrojejunostomy/gastric pouch reconstruction in
child
16-Laparotomy exploratory/gastrectomy partial+Roux-en-Y
17-Laparotomy resection small bowel
18-Laparotomy colic CA-Extensive colectomy
19-Laparoscopic appendicostomy in children
20-Laparoscopic pancreatic biopsy
21-Excision of abdominal mass
22-Excision mass back and gluteal excision
23-Anal mass excision
24-Fissure in ano-lat internal sphincterotomy
25-Hemorrhoidectomy internal & external
26-Abdominal perineal resection/vulvectomy unilat partial /myocutaneous
flap/reconstruction vulva /perineal reconstruction
27-Pilonideal cyst excision
28-Radical mastectomy
29-Mastectomy modified radical
30-Excision of tail of breast
31-Partial mastectomy+axillary node
32-Total mastectomy
33-Mass breast excision biopsy w/without ultrasound guided needle localisation
+lumpectomy
34-Lipoma scapula excision
35-Excisional biopsy post chest wall
36-Thyroidectomy
37-Thyroid lobectomy
38-Parathyroidectomy
39-Excision thyroglossal cyst
40-Tracheostomy permanent
41-Infusaport insertion
42-AV access
43-Thrombosed AV fistula/fistulogram+graft
44-Leg ulcer excisional biopsy
45-Debridement extremity lower bilat leg wounds
46-Thoracoscopy video assisted pleurodesis sterile talc
47-Pacemaker insertion
48-External rotation of VP shunt
49-Fusion extreme lat interbody w/2C-arms
43-Thrombosed AV fistula/fistulogram+graft
44-Leg ulcer excisional biopsy
45-Debridement extremity lower bilat leg wounds
46-Thoracoscopy video assisted pleurodesis sterile talc
47-Pacemaker insertion
48-External rotation of VP shunt
49-Fusion extreme lat interbody w/2C-arms
50-Externalisation of ventriculo peritoneal shunt (revision)of head
51-I &D abcess extremity lower hip
52-Decompression of ulnar nerve
53-Excision of shoulder mass
54-Excision of thigh mass
55-Correction polydactyly bilateral hands in children
56-Excision soft & lesion face,head,neck
57-Removal of hardware finger 5th
58-Removal of fingernail+repair nail bed
59-Excisional biopsy Left forearm
60-Excision back mass
In summary I attended : 37 cases in February,45 cases in March,30 cases in April
which makes a total of 112 cases among them 60 different new cases during the
three months.Thoses cases were performed by 25 different surgeons through 11
operating rooms. The surgeons were from different field:General
Surgery,Pediatric surgery,Cardiothoracic,Vascular,Plastic and hand
surgery,Neurosurgery,Urology,Orthopedics.
Residents Activities
I attended the local residents activities:Morning report(6:00AM),rounds with
the different team and attendants,thursday academic activities:General surgery
board examination preparation & general surgery courses,morbidity and
mortality cases,tumor Board,residency survey,clinical competency.
I attended special session courses with Dr Rimpel Bernard on traumatology and
training on some special surgical devices:GIA & TA staplers,trauma trays,etc…
Also I attended special informations on hernia meshes with St Arromand
Richard(Field clinical Specialist).
Other Rotations
I went to the Emergency Department doing rounds with attendants and
residents, to the simulation lab,to the vascular lab,also to the hematooncology,the radiotherapy oncology and to the radiology departments.
Special Conferences
I attended some special conferences:
*New York Society of Colon and Rectal surgeons/ Residents Night 2012:New
advances in colo-rectal surgery-March 15,2012,NY,USA.
*American Hernia Society:5th International Hernia Congress-The world hernia
celebretion-March 28-31,2012,NY,USA
*American Burn Association:44th Annual Meeting-April 2427,2012,Seattle,Washinton,USA
Medical externship survey
Every two other weeks,me and Dr Alex Durosier,the other haitian
resident(Internal Medicine-HUEH) will meet Dr Nacier and Dr Leblanc with
sometimes Dr Louisdon Pierre and Dr Myriam Germain. We would give report of
our experience and activities during the previous two weeks in the hospital. We
would talk also about some difficulties in our lodging.I had to set forth
lectures:Ainhum,Hibernoma,MACE …
Money Report
An amount of $ 2150 US in total was given to me for winter
clothes,metrocard,meal,mobile phone subscription.There were more for laundy
card and meal tickets were given to us. Also we we were refilled of supermarket
goods every two weeks.
Leisure time
I enjoyed so much:
*Brooklyn,NY tour:Brooklyn Bridge walking tour,Brooklyn Parks etc…
*Manhattan,NY tour and restaurants
*New Jersey,NY visiting my friend Samuel L. Davis office
*Long Island,NY,AMHE annual fundraising gala/Tabou Combo: I enjoyed taking
part of the AMHE 40th anniversary Annual Fundraising Gala,March 31,2012,Long
Island,NY,USA. where I had the oportunity to give a speech in the name of all
haitian residents.
*Seattle,WA,tour:Burn Advocates Network hosting in Sunset cruise and salmon
roast around Seattle’s Lake Washington/Elliot Bay:Americas most interresting
homes(Bill Gates…) and the Seattle Skyline from the water view. I went to the
American Burn Asssociation Space Needle party and the 44th anniversary of the
American Burn Association Annuel Banquet.
*Sports:walk,run…
Worship
I enjoyed going to the ”Eglise Baptiste D’expression Francaise” on Clermont
Ave,Brooklyn,NY,USA,which is three blocks from the hospital.
Comments and Suggestions
I was very satisfied of this Medical externship.I had the opportunity to attend as
much surgeries as possible from different surgeons in different field working with
a rich mean of technology.I had the oportunity to compare our surgical
techniques(european)to the US surgical tehniques cause most of our attendants
in Haiti were trained in Europe .
I suggest that rotation in a trauma center be part of the externship;also a better
relationship between the local residents with the haitian residents;medical and
malpractice insurancies for the externs,a surgeon can be added to the
coordination of the surgical externship;TV cable and our own Internet access.
Conclusion
I was amazed of the organization of the externship by the
AMHE,also by the wonderful determination,availibility and coordination of Dr
Nacier and Dr Leblanc to make the medical externship a success.Congratulations!
I dearly wish that the other haitian general surgery residents will benefit and
more from all my blessings.And sure the one who will take advantages of this
externship are the patients of Haiti which is the goal of this program.